Physical Therapy and the Alternative Payment System

Payment reform systems offer a way to achieve greater reporting accuracy, promote quality care and minimize fraud. To improve quality of care and create an accurate payment system built upon providing medically necessary physical therapy services, the APTA has proposed to reform payment for outpatient physical therapy services by transitioning from the current fee-for-service, procedural-based payment system to a per session payment system. We have two experts joining us in this week’s podcast to discuss Alternative Payment Systems.  Connie Ziccarelli, Principal & Chief Operations Officer and Jodi Woodward, Director of Medical Billing at Rehab Management Solutions share insight on alternative payment systems.
The new payment system is quite different than the payment system in place today. Currently, services are are coded with CPT codes. The Alternative Payment System looks to use just 12 codes in total for physical therapy services.  Although, learning the new system may be a challenge at first, the new alternative payment system should over time eliminate code choice, edits and bundling. Discover more about Alternative Payment Systems and how you can best prepare for them by listening to the full podcast now.
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One Comment

  1. Posted September 10, 2012 at 3:57 pm | Permalink

    Thank you for your presentation of the Alternative Payment System (APS) being developed by the American Physical Therapy Association. To add some additional information, please consider the following:
    1. There was mention of the “subjectivity” of the scale (limited, moderate, significant). In testing these concepts with physical therapists, consistent agreement was reached when actual scenarios were presented. However, it is recognized that there is a need for many others (including payors and regulators) to also be able to consistently categorize patients. Consequently additional definitions and examples are being developed to help those who may need additional support.
    2. For the last two years, APTA has been very active in introducing the APS concept to a variety of audiences, including payors and other professional societies, as well as the AMA itself. For example, formal presentation was delivered to the Health Care Professionals Advisory Committee (HCPAC)of the Relative Value Update Committee in April, 2012, and numerous meetings have been held with the American Occupational Therapy Association. Insurers who have been briefed include Blue Cross Blue Shield Plans, United Healthcare, and Aetna. CMS has received two presentations.
    3. While the APS is being developed, the different categories to which the patients might be assigned have been given a number. This is a “working number” for convenience. It is not our intent to independently promote the use of a new numbering scheme. The APS will be presented to the CPT Editorial Panel for their approval through the coding application process and, when completed, will receive CPT codes which can be used for billing purposes, similar to the current use of CPT codes.

    Thank you again for your discussion of the APS and I would certainly want to echo the point that the key to the success of this, or any coding system, will undoubted rest with the adequacy of the documentation that supports the services and billing.

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